Over 50? Expert Doctors Explain Why You May Be at Higher Risk for a Sexually Transmitted Infection

Sexually transmitted infection rates in older adults are at an all-time high—and rising faster than any other age group. Doctors explain what's up.

Over the past decade, there’s been a dramatic increase in the spread of sexually transmitted infections (STIs) among older Americans. According to research published in the International Journal of Environmental and Public Health, STI cases in people over 65 have doubled in the past 10 years—and, in some cases, have risen even more sharply, says Ashley Lipps, MD, an infectious diseases physician at The Ohio State University Wexner Medical Center. “For example,” Dr. Lipps explains, “the number of reported syphilis cases increased seven times between 2011 and 2021 in those ages 55 and older.”

Adds Christine Greves, MD, a board-certified obstetrics and gynecology physician and surgeon with Orlando Health Medical Group, data from the Centers for Disease Control and Prevention (CDC) shows similar spikes for other common STIs. Over the same 2011 to 2021 period, chlamydia rates in older adults rose about 161%, and gonorrhea rates went up 433%.

While actual numbers of sexually transmitted infections are higher in young adults, these sharp increases among older generations are sounding alarms in some parts of the medical community. Here, two doctors who are experts in sexual health explain what’s been going on.

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Why STIs are rising among older Americans

There’s a stigma that we become less sexually active with age—and while it depends on the individual, Dr. Greves says this is by and large a myth.

Adds Dr. Lipps: “Studies have shown that sexual activity remains an important part of life for many older Americans.”

Some of this is thanks to what’s been colloquially referred to as “the little blue pill” since 1998, when the FDA first approved Viagra, along with a wider cultural acceptance of medications to treat erectile dysfunction that have hit the market since then.

For the fairer gender, says Dr. Lipps, “There’s also more widespread use of … hormone therapy for women, which helps older adults remain sexually active.” In fact, according to 2023 research published in The Lancet, over half of people aged 75 to 85 years report having sex two to three times per month, and 23% say they have sex once or more per week.

With these evolving methods of maintaining sexual health, if you’ve seen any of the cheeky memes suggesting this kind of rendezvous is happening in nursing homes, Dr. Greves says that’s actually not entirely false: “Assisted living facilities facilitate more contact with others,” Dr. Greves says. While data is limited, one 2022 University of Kansas study showed that 84% of Kansas nursing home administrators reported sexual expression among residents.

Another factor is that swiping-right isn’t just for the younger tech set: Pew Research Center data reports that one in six Americans over age 50 say they’ve used a dating site or app.

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There’s also biology to consider…

While seniors are maintaining full, active sex lives, Dr. Greves mentions a pervasive mindset that since they aren’t concerned about pregnancy, this demographic is less likely to use protection. The International Journal of Environmental and Public Health research suggests less than one-quarter of adults over age 50 use condoms.

In addition, the stigma surrounding sexuality in older adults leads to decreased screening and reduced emphasis on safe sex counseling by healthcare providers, Dr. Lipps explains. Per The Lancet research, only 17% of older adults spoke with their physician about their sexual health in the prior two years—and over 60% of those conversations had to be initiated by the patient.

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Plus, there are also no formal recommendations for STI screenings in older adults, Dr. Lipps says. This is a problem because some STIs can be asymptomatic—so unless someone is screened for a specific infection, the diagnosis can be missed altogether. “STIs may also have non-specific symptoms, which could be misdiagnosed if clinicians are not keeping a high degree of suspicion for STIs,” she says. “Syphilis, for instance, can cause a rash, and gonorrhea can cause arthritis symptoms.”

Adds Dr. Greves: Pain associated with an STI can mimic uncomfortable symptoms of an ovarian cyst or inflammation, or vaginal discharge from chlamydia or gonorrhea could look like bacterial vaginosis. “A sore throat could be due to gonorrhea, or a virus, or strep throat,” she says. “Syphilis can present in all different types of ways—it can present as warts, rash, itching, pain, sores. So, the differential is huge.”

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Are sexually transmitted infections more dangerous for older adults?

Our immune system function naturally declines with age, which can make you more susceptible to an STI and make it harder for your body to deal with the infection. “Older adults are also more likely to be diagnosed with an STI at later stages,” Dr. Lipps explains—and this can cause more severe health complications. “Syphilis, while easily treatable at an early stage, can cause severe manifestations—such as neurologic or cardiovascular involvement—if left untreated for long periods of time.”

Dr. Greves adds that undiagnosed Hepatitis B and C can result in liver failure, and gonorrhea or chlamydia can lead to pelvic inflammatory disease and chronic pain.

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Staying in good sexual health as an older adult

From the medications that help seniors maintain their sex lives to greater dating pool access, sexual activity into your golden years is a considerable net positive. Research suggests that sustained sexual activity can contribute to more successful aging, longevity, and better physical and mental health. If physical intimacy isn’t quite as important to you, further research—including a longitudinal Harvard University study—has suggested simply feeling close emotional connection is one of the greatest contributors to longevity.

Some of the younger “Judy Blume” generation may be slightly more comfortable than their elders in asking questions or being candid about their health as it relates to their intimate lives—so, Dr. Greves says, more healthcare professionals are being proactive in tending to seniors’ sexual health. “In our practice, we [start] the discussion of sexual activity, opening the door in a non-judgmental way,” she says. If your provider doesn’t prompt a conversation, you should disclose your sexual activity with your doctor.

“It is important to discuss your sexual health and risk factors for STIs with your healthcare provider,” Dr. Lipps emphasizes, adding that patients who fit the following descriptions should be screened for sexually transmitted infections:

  • “Those who are sexually active with a new partner,
  • those who have multiple sex partners or who have a sex partner with concurrent partners,
  • and in those who practice inconsistent condom use.”

Editor’s note: Both medical doctors who served as sources for this story noted the professional preference for the phrase sexually transmitted infections instead of sexually transmitted diseases.

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Sources

People:

Ashley Lipps, MD, an infectious diseases physician at The Ohio State University Wexner Medical Center

Christine Greves, MD, a board-certified obstetrics and gynecology physician and surgeon with Orlando Health Medical Group

Journals:

International Journal of Environmental and Public Health: "Sexually Transmitted Infection Knowledge among Older Adults: Psychometrics and Test–Retest Reliability"

The Lancet: "Sexual activity of older adults: let's talk about it"

Gerontology and Geriatric Medicine: "Sexual Expression, Policies, and Practices in Skilled Nursing Settings Serving Older Adults: An Updated Assessment in the State of Kansas"

Pan American Journal of Public Health: "A systematic review of sexual health and subjective well-being in older age groups"

Websites:

Pew Research Center: "Dating at 50 and up: Older Americans' experiences with online dating"

Leslie Finlay, MPA
In addition to The Healthy, Leslie has written for outlets including Buzzfeed News, VeryWell Fit, and WebMD.com, specializing in content related to healthcare, nutrition, fitness, and mental health. As a lifelong athlete and instructor, she’s passionate about learning and communicating the latest in health and wellness..